TO005
POSITIVE INCOMES OF NUTRITIONAL SUPPORT MODALITIES IN TERMS OF INFLAMMATION AND CARDIOVASCULAR STATUS

Introduction and Aims: Protein energy malnutrition is one of the strongest predictors of morbidity and mortality in maintenance hemodialysis (MHD) patients. Many reports indicate that there is a high prevalence of malnutrition up to 40% , and has a strong association with inflammation and cardiovascular disease (CVD) as well as lower quality of life in this population. The aim of this study was to compare the nutritional modalities by means of biochemical parameters, arterial stiffness and bioimpedance analysis.

Methods: We designed a prospective study with 56 malnourished MHD patients (mean age: 61.8±12.3 years, duration of hemodialysis: 7.9±5.1 years) . Patients were divided into 4 groups according to nutritional support (NS) modalities as group 1 (patients received only oral NS; n: 14), group 2 (patients received only paranteral NS; n: 14), group 3 (patients received both oral and paranteral NS; n: 10) and group 4 (control group; n: 18) for 6 months. Biochemical parameters were assessed from monthly clinical visits. Normalized protein catabolic rate (nPCR), malnutrition-inflammation score (MIS), body composition (fat mass [FM], fat-free mass (FFM) muscle mass (MM, body mass index (BMI)) by multifrequency bioimpedance analysis (BCM, Fresenius). Pulse wave velocity (PWv) was determined from pressure tracing over carotid and femoral arteries using the SphygmoCor system.

Results: Demographic characteristics (age, gender and duration of dialysis) of patients were similar in 4 groups. Mean serum albumin (p: 0.001) and nPCR (p: 0.001) levels were increased in group 2 and 3 respectively. Although serum C-Reactive protein was similar in group 1 and 2; it was significantly decreased in group 3 (p: 0.001). MIS value was decreased in group 1, 2 and 3 (33%, 14.7% and 14.2%, respectively), however the most significant decrease was detected in group 3 (p: 0.001). In body composition analysis; FM (p: 0.006), FFM (p: 0.0049), MM (p: 0.001) and BMI (p:0.001) levels were significantly increased in group 2 and 3, respectively. BMI was significantly increased in group 1,2 and 3, though the most significant increase was in group 3. In linear regression analysis, MIS value (p: 0.004) and serum albumin levels (p: 0.001) were detected as the predictors of PWv.

Conclusions: By this trial, we demonstrated that treatment of malnutrition especially by combined nutritional support improves arterial stiffness and inflammation related advers outcomes in MHD patients.